Alzheimer: What is Alzheimer Symptoms - Causes - and Treatment ?
Alzheimer'S Disease
Alzheimer's disease (Alzheimer's disease) is considered the most common cause of dementia. It is accompanied by symptoms such as memory loss and orientation problems
What is Alzheimer's?
The Alzheimer's disease, also known as Alzheimer's disease, is the best known and most common cause of dementia. According to the International Classification of Diseases (ICD-10), the dementia is an acquired disorder of memory and of the mind, which is so pronounced that by professional and / or private activities of daily living are affected. The fault must exist under this classification system for at least six months.
According to estimates currently suffering worldwide about 35 million people with dementia. In Germany the number is currently estimated at about 1.5 million, of which affects approximately one to 1.2 million people with Alzheimer's. According to projections, this figure will continue to rise over the coming decades. Women are much more common among Alzheimer's than men. Experts explain this primarily with the different life expectancy of both sexes.
Alzheimer's disease was first described in the early 20th century by the Bavarian psychiatrist Alois Alzheimer (1864-1915). He led detailed studies of patients with behavioral problems and acquired deficiencies of mental ability. In the train of these studies Alois Alzheimer studied the brains of deceased patients and brought the results of his observations in connection. His findings published the scientists for the first time in 1906 in a pioneering, but later most acclaimed work. He had managed to describe a new, independent disease.
Symptoms of Alzheimer's disease
The Alzheimer's disease usually begins with a poor memory. Even signs as orientation and language difficulties and odd behavior suggests. In many patients, changing, especially in advanced stages of the disease, the personality.
Alzheimer's disease not only has far-reaching consequences for those affected, but often also means a huge financial burden on families and carers. In order to save the sick and their families as much suffering, it is necessary at an early stage to make the diagnosis and treat the symptoms with medication.
Alzheimer's Disease: Causes
In Alzheimer's disease can be observed in the brain characteristic changes - for example, certain protein deposits
The exact cause of Alzheimer's disease is not known yet. In the patients, however, there are increasingly characteristic protein deposits that have already been observed by Alois Alzheimer and probably play a key role. This is for a so-called senile plaques, which consist of protein fragments (beta-amyloid peptide). On the other fibrous deposits, known as neurofibrillary tangles, which consist of abnormal, clumped / aggregated protein (tau protein with too much attached phosphate groups). In addition, Alzheimer's disease is a change in levels of certain chemical messengers (neurotransmitters) in the brain associated.
Beta-amyloid and tau protein
Experts believe that a particular protein, called beta-amyloid, plays a central role in the development of Alzheimer's. There is a cleavage product of a larger protein molecule whose function is not known so far. In the gray matter of Alzheimer's patients to find beta-amyloid deposits called senile plaques, particularly in high density.
The deposits consist of a central amyloid core which is of diseased nerve cell processes, reduced synapses (junctions between nerve cells) and activated astrocytes, the most common cell type in the brain, surrounded. In many patients, the amyloid is deposited in the walls of small blood vessels. Thus increasing their permeability may deteriorate, which affects the oxygen and energy supply to the brain.
Has not been definitively explained why there is the pathological accumulation of beta-amyloid. For it has been shown that the protein is produced in the human body is constant and throughout life. Here, the highest concentrations are found in the nerve cells (neurons), where beta-amyloid as a byproduct of normal metabolism process. During aging, so the assumption is then deposited amyloid increases in gray matter between nerve cells. This "normal" senile plaques are, however, much rarer than is normally sown in the case of Alzheimer's disease.
Typical of Alzheimer's disease is that there is a loss of synapses and in the further course to the death of nerve cells. This is associated with the formation of abnormally modified protein (tau Potein), which is deposited in the form of fibrils, the fibrils in the brain. These are the neurofibrillary tangles already described by Alois Alzheimer.
These detectable within many nerve cells tangles consist of the so-called tau protein, a really normal part of the cytoskeleton. In Alzheimer's disease, the tau protein but is loaded excessively with phosphate groups. This stabilization and transport processes can be disrupted in the cell, which ultimately leads to their demise.
Altered neurotransmitter concentrations
Characteristic of Alzheimer's disease is also the altered concentration of certain neurotransmitters (neurotransmitters) in the brain. These mainly include acetylcholine and glutamate. Both substances are for the normal function of nerve cells and the signal transmission between neurons of central importance. Since neurons perish in different brain areas, this leads on the one hand that there is a lack of acetylcholine. On the other hand, much glutamate is formed excessively.The role of genes
Again and again the question is asked whether the dementia, especially Alzheimer's disease, is inheritable. The risk of developing Alzheimer's disease is cancer in first-degree relatives is slightly higher than in the general population. This type of inheritance is probably based on a variety of genes that create a so-called predisposition - that increase the risk of developing Alzheimer's disease. In rare cases, Alzheimer "fixed" (dominant) anchored in the genes. Several such genes are known so far and who bears such a gene, it can pass on to his children.
The with the "fixed Alzheimer's genes" inherited diseases occur more often on relatively early from the age of 30. The benefits of genetic testing, with which would prove who has appropriate genetic is yet controversial. Among other things, because so far no medical measures are available that would allow a cure of chronic disease and avert the threat of dementia safely.
At present people is from families where the dominantly inherited form of Alzheimer's disease occurs, the voluntary participation of DIAN open. DIAN stands for "dominantly Inherited Alzheimer Network", an international network for the dominantly inherited Alzheimer's disease. It was founded in the US in order to better explore the genetic forms of Alzheimer's disease and provides these patients also promising therapies in studies.
Alzheimer's Disease: Symptoms
Alzheimer can manifest itself in various ways. Symptoms such as forgetfulness, speech and orientation difficulties and changes in personality indicate
Mostly, it is a striking forgetfulness that the question of incipient dementia can germinate in the affected older people themselves or with their relatives. If this memory disorder actually on an Alzheimer's disease is due, then the brain has usually already gone through at this time a many-year-long gradual change. Unbeknownst dying in the brain first from the extensions and connections of nerve cells and later the nerve cells themselves. The disintegration leads to the decline of brain tissue (atrophy). This damage spreads insidiously over the brain.
Depending on the damaged area of the brain to be located there features and capabilities. So dwindle little by little short-term memory, the ability to perform daily chores, the judgment and the language. It changed the expression of feelings, the behavior cognition and communication. If the dementia progressed, the patients also often lose control over urination and defecation.
Characteristic symptoms of Alzheimer
Although the symptoms and discomfort of dementia sufferers are usually very diverse, yet can be seen some characteristic signs on closer observation. The following changes a person to make him or his noisy environment:
Forgetfulness , loss of short term memory, and later long-term memory (the data subject is constantly repeated the same questions; forgets the current date)
To do difficult and everyday domestic tasks correctly (an experienced housewife makes a sudden error while cooking food, washing machine or stove can no longer be operated correctly)
Problems linguistically express (person finds no words; used substitute words)
Loss of orientation over time, space and place (the data subject does not know when Christmas is, is first found in foreign, later in familiar surroundings no longer cope, running around at night, sleeping during the day)
Lessening of discrimination
Problems with concentration and abstract thinking (the data subject can cause no more account; can no longer fill Bank Transfer)
Incorrect assignment of objects and situations (the data subject shall butter in the closet; goes in her dressing gown to go shopping)
Occasionally, blurred vision despite normal eye function on (faces and objects are not detected, affected accesses next to it)
Behavioral changes (the data subject is exaggerated suspicious; has sudden extreme mood swings)
Personality disorders (previously balanced person becomes aggressive; developed unfounded fears)
Listlessness (person loses general interest in current affairs, work and hobbies; attracting more and more back, is depressed )
Course of Alzheimer's disease
The course can be individually very different. Alzheimer's disease is a chronic but progressive process, which can be now delayed by medication, but not permanently averted. The course can be divided into three stages, each of which - with individual differences - can last for several years:Symptoms of Alzheimer's at an early stage
Memory and memory disorders
Mood swings
Problems in the execution of difficult tasks, loss of performance
Loss of precise linguistic expression
Significantly reduced capacity for work and social contacts
Symptoms in the middle stage
All intellectual performance degradation reinforce as well as the changes of psyche and personality
The patient is indeed often even to a certain extent capable of independent living, but increasingly requires support in everyday practical matters
Symptoms in the late stage
The patient is no longer able to live unassisted. Personal hygiene is alone no longer possible, short-term memory is almost completely extinguished
Physical symptoms and their consequences worsen the situation: seizures, loss of control over the posture (falls) and on the bladder and bowel function, and swallowing disorders can occur, for example. The leading cause of death in Alzheimer's patients are infections .
Alzheimer's Disease: Diagnosis
With various tests and examinations can be an Alzheimer's disease circle or exclude relatively well
After-honored doctrine of neuropathologist and forensic pathologist can diagnose Alzheimer only be made after death by a microscopic examination of the brain with a hundred percent certainty. Nevertheless, there are now many ways to encircle a clinically probable Alzheimer's disease in patients diagnostically or exclude.
The following conditions make the existence of an Alzheimer's disease very likely if other diseases have been ruled out, which may be associated with these or similar symptoms:
- Memory impairment and in the further course of the disease usually at least one of the following symptoms: speech disorders (aphasia), apraxia (patient has a movement disorder, although it is motorized healthy, eg no longer appears in the jacket sleeve), agnosia (patient has problems recognizing objects although the sense organs are intact), difficulties to plan, to solve problems and abstracting
- acquired, profound impairment of daily living (for example, the inability to self-lubricate a sandwich to go shopping yourself, or the like)
- gradual onset of symptoms
- continued persistence of disturbances
- progressive course
For basic diagnostic steps include:
- The doctor collects a detailed medical history of the patient.
- This is followed by a physical examination follows.
- Standardized tests provide information on the intellectual achievements and abilities. In addition, it is important to assess how well the patient is still able to carry out activities of daily life. Particularly well-known brief test method are the Mini-Mental State Examination (MMSE), the time-drawing test or DemTect (dementia detection). Sometimes a detailed neuropsychological diagnostics makes sense.
- Help blood tests, other causes of dementia, such as infections , vitamin deficiency or an underactive thyroid excluded.
With imaging techniques such as CT or magnetic resonance imaging (CT or MRI ), preferably MRI, the brain structures can be assessed and found evidence of Alzheimer's or other dementias typical brain changes. In addition, detected with imaging methods, among other vascular diseases of the brain or tumors are excluded.
Alzheimer's Disease: Therapy
In addition to drugs that slow the progression of dementia, various non-pharmacological treatment approaches may help in Alzheimer
Heal one can Alzheimer disease infection previously. But there are several medications that can contribute to the dementia progresses less rapidly and the memory improves again. With various other therapeutic measures can be the mental abilities of the person concerned and promote relieve symptoms. Especially in advanced stages it is important to provide good nursing care of those affected and to relieve the relatives.
Non-pharmacological treatment
Non-drug treatment measures are essential in order to improve the symptoms, quality of life and the independence of the Alzheimer's patients and to relieve the attending members and caregivers. Such measures mainly include everyday-on training and have physical and mental stimulation to the target.
To supervise the patients optimally, various specialists should collaborate. These include the general practitioner, the geriatrician who (Geronto-) psychiatrist, neurologist or psychiatrist, as well as physiotherapists, occupational therapists, speech therapists, home care services and social workers. Also important is the education and training of relatives and nurses.
As a meaningful non-drug measures have proved effective: the adjustment of the daily routine and the living conditions (milieu therapy), labor and occupational therapy ( occupational therapy ), taking into account the life history of the individual patient (biography work), special respect and acceptance of the patient as a whole person (Validation), treatment of speech disorders ( speech therapy ), physiotherapy (physical therapy), as well as art and music therapy. Finally, the patient needs in the course of the disease increasingly nursing care. It has been shown that the use of medical nutrition in the early stage leads to an improved memory performance.
Drug therapy
The slides listed below medications called anti-dementia drugs, are used in the treatment of Alzheimer's dementia for improving memory and the everyday coping with individually varying degrees of success. The aim of this treatment is to maintain the independence and quality of life of dementia sufferers as long as possible and to reduce the maintenance effort.
Cholinesterase inhibitor
In the early and mid-stage drugs come into question, which inhibit the enzyme cholinesterase, which breaks down the neurotransmitter acetylcholine. In order for the neurotransmitter acetylcholine for signal processing in the brain is again increasingly available. The currently used drugs in this group are: donepezil, galantamine, rivastigmine.
For all three means there are numerous study results from evidence of an improvement in brain performance and life skills. However, the tablets may also have side effects. There may be symptoms such as nausea , vomiting and diarrhea may occur. Such undesirable effects are less and less frequently, if the treatment started at a lower dose of medication and this is then slowly increased. There is some evidence that cholinesterase inhibitors also at an advanced stage of Alzheimer's disease can be effective. Further treatment may be useful.
Memantine
The drug memantine affects the receptor of the neurotransmitter glutamate in the brain. With Memantine can be the attention and the everyday skills improve - particularly in advanced dementia. The tablets should be on the low doses at the beginning and the dose is then increased. Side effects of Memantine may include: dizziness , inner and physical restlessness and hyperexcitability. General Memantine shows fewer side effects than the acetylcholinesterase inhibitors. Memantine is in the middle and late stage effectively. The effect of memantine has not been established in the early stages of Alzheimer's disease.
Alzheimer's Disease: Find out more
What is a primary dementia, which is a secondary? How many people suffer from Alzheimer's? That you can read here
Primary and secondary dementia
Dementias are divided into primary and secondary forms. With up to ten percent of all cases of the disease is secondary dementias. This refers to those who, for example, as a result of drug effects, metabolic disorders, vitamin deficiencies or depression develop. Also brain tumors or changes that result in increases in pressure in the brain - such as drainage disorders of the cerebrospinal fluid (CSF) - can cause symptoms of dementia. Manages a successful treatment of the underlying disease, the symptoms of dementia can partially or completely regress.
Contrast Primary dementias go directly from basic walking tissue in the brain. The primary dementias are not yet curable. Alzheimer's disease is the most common form of primary dementia, followed by vascular-related (vascular) forms and mixed dementia (Alzheimer plus vascular dementia ). Other primary dementias are the frontotemporal dementia (Pick's atrophy), the Lewy body disease and Parkinson -Demenz.
Alzheimer's is the most common dementia
Approximately 1.5 million people suffer from dementia today in Germany. Approximately two-thirds of those affected are suffering from Alzheimer's. With around 200,000 dementia patients circulatory disorders (vascular dementia) are to blame, that the brain functions are damaged in the long term and lasting. The remaining dementia sufferers suffer from mixed forms or rarer dementias.
An Alzheimer's dementia should not be confused with supposedly normal aging. But it is a condition that typically occurs primarily in the age over 65 years. Approximately one percent of over-65s are affected by Alzheimer's disease, at the over-80s is about 20 percent and more than 90-year-old people, it is almost half.
Alzheimer's Disease: Expert Advisory
Mrs. Professor Christine von Arnim is a specialist in neurology
Mrs. Professor Dr. med. Christine von Arnim is a specialist in neurology. She wears the suffixes "Clinical Geriatrics" and "palliative care". She received her clinical and research training in Freiburg, Mannheim, Harvard and Ulm and his habilitation in Ulm in 2006. Mrs von Arnim directs the memory clinic at the University Hospital of Ulm and is senior physician at the city's Department of Neurology. The expert has been working for years with scientific Alzheimer's disease.
